AGH Neurosurgeons Use New Approach To Access Difficult to Reach Aneurysms

Natalie Joyce was preparing for aneurysm surgery in February when she received literally heart-stopping news.

She didn’t have just one aneurysm, doctors had found a second behind her left ear. The first aneurysm, located near her left eye, could be removed through a tiny, barely noticeable incision in the crease of her eyelid. The second would be difficult to access and manipulate. To secure this growing weak spot in her artery, doctors would have to briefly stop her heart.

“When they told me about stopping my heart, it bothered my husband a lot,” Joyce said. “But, it didn’t bother me at all. They’ve done it for so many years with heart surgeries.”

The 44-year-old mother of two from Freeport, Armstrong County, underwent her second aneurysm repair surgery in May. Neurosurgeon Khaled Aziz, MD administered adenosine, a drug that causes the heart to stop for a few seconds, resulting in a dramatic decrease in blood pressure.

Stopping her heart for just a few moments and reducing blood flow to the area made the aneurysm less rigid, giving Dr. Aziz additional flexibility to manipulate it more freely.

“The location of Ms. Joyce’s aneurysm made it particularly challenging to reach and clip,” said Dr. Aziz, Director of the Center for Complex Intracranial Surgery at Allegheny General Hospital. “By stopping the heart and preventing it from sending blood to the brain very briefly, I got a quick window in which I could grasp and maneuver the aneurysm with reduced risk of rupturing it.”

Due to the size and complexity of Ms. Joyce’s aneurysm, Dr. Aziz clipped it to prevent any rupture, using two clips to block future blood flow to the aneurysm.

“I didn’t feel any heart palpitations or any effects from the medication,” Ms. Joyce said. “If the doctor didn’t tell me he was stopping my heart, I would have never known.”

Ms. Joyce said her recovery from the surgery with adenosine was a bit quicker than her prior aneurysm surgery – she left the intensive care unit two days sooner this time and remembered more of the day after her surgery.

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